Large Planum Sphenoidale Meningioma in a Patient with Bilateral Optic Disc Pallor

Differentiating non-glaucomatous and glaucomatous etiologies of optic neuropathy clinically can be challenging. We describe a patient with glaucoma and a concurrent planum sphenoidale meningioma to highlight the importance of fundoscopic examination and ancillary diagnostic tests. Despite thinning of the retinal nerve fiber layers (RNFL), tumor resection led to encouraging improvement in postoperative visual field (VF) testing. This suggests that the presence of reasonably preserved nerve fiber layers is a prognostic factor for visual field recovery following neurosurgical intervention in cases involving the chiasmal region.

A 73-year-old female presented with a 1-year history of headaches, intermittent ocular pain, blurred vision, and gradual loss of peripheral vision in her left eye. Initial evaluation revealed normal intraocular pressure and asymmetric cupping of 0.6 and 0.4 in the right and left eyes, respectively. While normal tension glaucoma was a possible diagnosis, her bilateral optic nerve head pallor, thinning of the RNFL, and VF defects that did not match the cupping raise suspicion of an intracranial lesion. Magnetic resonance imaging (MRI) and histopathology confirmed a large planum sphenoidale meningioma, which was surgically resected. Postoperative recovery showed drastically improved VF and resolution of symptoms, though visual acuity remained suboptimal.

Surgical resection of a large tumor size, as seen in our patient, can still result in visual field improvement despite suboptimal recovery of visual acuity. This case highlights the importance of considering intracranial tumors in the differential diagnosis to prevent long-term visual impairment.